There is consistent epidemiologic association between the presence of interstitial cystitis/ painful bladder syndrome (IC/PBS) and certain somatic syndromes (e.g., fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome) and psychiatric illness (anxiety, depression). While these associations are well established, their clinical significance has not been evaluated. A central hypothesis of this MAPP Discovery Site proposal is that certain IC/PBS patients have central abnormalities of pain processing. If true, then patients with multiple co-morbidities could represent a more severe disease phenotype which would be associated with worse clinical outcomes. We hypothesize that over four years of study, about 25% of women will have progression of IC/PBS symptoms, and 25% will have symptom regression;and that IC/ PBS patients will have a high rate of co-morbid systemic somatic symptoms at baseline (35%), that they will develop other regional pain symptoms and syndromes over time, and that these co-morbidities will be associated with IC/PBS symptom progression. The coexistence of multiple pain syndromes in individual subjects will reinforce the idea that IC/PBS patients have a central disturbance in pain processing rather than a disorder confined to the bladder. We hypothesize that clinic based patients and community women who have both sought and not sought urologist care each represent a subset of the women with bladder and other co-morbid symptoms, and that they differ from each other in terms of predominance and severity of co-morbidities and psychosocial characteristics. Using research methods developed by our group as part of the ongoing RAND Interstitial Cystitis Epidemiology (RICE) Study, we propose to recruit and follow a community-based probability sample of women with IC/PBS symptoms in Michigan, Indiana and Ohio, and combine them with a convenience sample of female IC/PBS patients from the University of Michigan urology clinic. These samples will allow us to assess and follow subjects with various degrees of IC/PBS severity. These methods are easily applied to additional geographic regions, and we propose that this study be done as a collaborative project with other MAPP Discovery Sites. Specific Aims: AIM 1 - To study the natural history of IC/PBS. AIM 2 - To identify risk factors associated with symptom progression in women with IC/ PBS. AIM 3 - To assess factors associated with healthcare seeking in individuals with IC/PBS symptoms.